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formypops
New Member


Date Joined Nov 2010
Total Posts : 12
   Posted 12/12/2010 11:11 PM (GMT -6)   
Hello. I just want to start off by saying  i really admire the support that is found on this page and everyone's willingness to share their stories. This support is great and even though I lurk more than I post, it is really helpful and really appreciated! So far my father (Hi Dad if you are reading this)..has met with Dr Samadi and really liked him. He is a big Davinci supporter so his opinion was purely Davinci. They have an appointment with Dr. Taneja from NYU this week. He was a more radical guy but started Davinci in 08 but still does both. Anyway as I read many of your profiles I see such a mix in either Radical or Davinci and if you are willing to share I am wondering why you chose the method you chose? i know everyone says it is an individual decision and it appears it may even be based on the "sales pitch" of the doctor or their skill per say....I know the statistics are very close in terms of side effects after...so I guess my question is, what was the main reason you chose 1 method over the other??? Did something stick out that made you say, no way am I doing Davinci or no way am i doing a Radical?! I guess if you look at it as black and white I would just assume everyone would choose the newer Davinci method because the recovery seems better so i know I must be missing something because I am still seeing alot of people that chose Radical...so why did you go the way you went? Sorry I rambled but i hope this makes sense! Thanks in advance for sharing!
 

geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 12/12/2010 11:19 PM (GMT -6)   
Hey, this is the place where you can always ask.
After reading posts for about two years, I have come to the conclusion that there is not much difference between the open and robotic except the size of the scars. I had the choice of two uros, one that did open and one that did robotic. My choice was for the guy with the most experience and that was robotic. My bottom line -- worry more about the experience of the doctor.

Jazzman1
Veteran Member


Date Joined Sep 2010
Total Posts : 1163
   Posted 12/12/2010 11:32 PM (GMT -6)   
I had open surgery, mainly because the surgeon I trusted preferred to do it that way. There were other arguments for open surgery that I found persuasive, but it was primarily the surgeon.

The thing that settled it was when I saw a medical oncologist for a second opinion. I told him I was wondering if I should go for robotic surgery in order to have an easier recovery. He recommended open surgery, saying that, "a year from now it won't matter a bit whether it took an extra couple weeks to recover from surgery." That clinched it.
Age 55
PSA: 8/09 2.69 -- 7/10 4.00 -- 8/10 4.11
--------------------------------------------------
Biopsy 8/10
Three of 14 cores positive: 10%, 60% & 80%
Stage T1C; Gleason 6
---------------------------------------------------------------
open radical prostatectomy at Cleveland Clinic 11/2/10
Post-surgical pathology: Gleason 7 (3+4)
Three positive margins; Stage T2c(+)
12/7/10 PSA: <.03

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 12/12/2010 11:39 PM (GMT -6)   
I had open by choice, as my surgeon was highly experienced in open only (nearly 30 years). Plus in my area, robotics was too new at the time and only around 15 had been performed. In the end, due to an anatomy issue in my prostate bed, I would have to have had open surgery anyhow, and if I had chosen robotic, they would have to had aborted it and switched to open.

david in sc
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

MarkMyWords
Regular Member


Date Joined Dec 2010
Total Posts : 55
   Posted 12/13/2010 12:45 AM (GMT -6)   
I consulted with both an open and a robotic surgeon. What persuaded me was that when they do open surgery, the base their decisions and "plan of action" on touch. My DRE showed no symptoms, yet the biopsy had 12 of 12 cores showing advanced cancer. With the robotic I felt it was more important to be able to move a camera into the area and visually look at things - hopefully being able to get a clearer cut and taking only what was necessary. I trusted both surgeons and they were very experienced. The last deciding factor was that the robotic surgeon was highly recommended by my family Doctor whom I trust implicitly.

I still recommend talking to multiple Doctors and getting multiple opinions - read - ask questions - talk to people (either on here or friends / family) - EDUCATE YOURSELF and make the decision you feel the most comfortable with. =)

Best of luck....
Father diagnosed in April 2010, 38 year old brother diagnosed in June 2010 and I was diagnosed in Sept 2010.
Age 45
Jul 2010 - PSA 10.1
Aug 2010 - Biopsy - 12 of 12 cores positive - Gleason 7 (3+4 on the right, 4+3 on the left)
Sept 2010 - CAT and Bone scans negative.
Nov 2010 - da vinci RP with negative margins. nerve bundles were not spared. negative lymph nodes. Pathology Stage pT3c.

BuiDoi
Regular Member


Date Joined Aug 2010
Total Posts : 234
   Posted 12/13/2010 3:35 AM (GMT -6)   

Robotics Vs open-Cut RP ???

The only observations that I can make is that a number of surgeons, and U-Docs said that open was the most reliable, and encourage me to go that way.

Bottom line - If you own a DaVinci machine, then you will want to use it LOTS and LOTS... .. . If you don't own such a machine, then you will be telling all about the problems with such machines (if any).

Now there is a book  ( yes - THAT book )   that has reported well on the statistics in Australia..

P87  http://ses.library.usyd.edu.au/bitstream/2123/6835/3/Let-sleeping-dogs-lie.pdf

In other words, robotic nerve-sparing surgery being promoted by the handful of surgeons who have invested heavily in it actually appears to make things worse. Doctors outlaying such investments plainly have a massive incentive to keep up a healthy throughput of patients using the equipment and one of the ways of doing this is to promote the advantages of better surgical outcomes to their patients.

Have a read of pages 71 to 88 - It explains a lot, if you can handle all the statistics.

Some interesting passages...
In other words, it wasn't until Dr Stricker  had performed 200 RALP operations, that the incontinence rates he was achieving were equivalent to those obtained by the RRP approach.

Implication - It is harder to get the same 'workmanship quality' with DaVinci.

The JAMA study of 1938 men followed for five years reported that, compared to routine “retropubic” radical prostatectomy, minimally invasive prostatectomy performed via robotic surgery “was associated with an increased risk of genitourinary complications (4.7% versus 2.1%) and diagnoses of incontinence (15.9% versus 12.2%) and erectile dysfunction (26.8 versus 19.2 per 100 personyears)”.

Implication - There are more "Problems" with DaVinci that open-Cut RP..  BUT statistically, is it significant?   There is a vague reference to one interesting fact. 

With the NSW-wide data showing two thirds of all men undergoing nerve-sparing radical prostatectomy being impotent at three years [102], it is reasonable to assume that one-year rates of impotency will be substantial.

Unfortuantely, you will find it very hard to get a clear direction from anyone, as each of us chose what we thought was the best, but one thing in common to all, is the thought that the experience of the surgeon is most paramount.  But - Remember Dr Strickers belief that you must have 200 DaVinci operations under your belt befor you start to achieve the results of open-Cut RP.

.

 


Nov 2009 = First-PSA 5.3 @ 60yo - Asymptomatic - DRE-Non-Palpable
Jan-'10 = TRUS Bx DX - AdenoCar T1c - GS(3+3)=6 , 5 & 45% max., L-MidZone
May-'10 = RRP-Nrv-Spare
Post Op. GS(3+4)=7, 1.1cm3, Pos Margins, EPE (focal) Lateral Left
Margin-Involvement (extensive) Posterior , Grade3 x 8mm
+8week PSA<0.01, ED-85%, Incont-30%
+16W PSA<0.01, ED -85%, Cont -5%
+17W First 'DRY' day. ED -90%

Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4119
   Posted 12/13/2010 6:26 AM (GMT -6)   
I went into the PCa blind and the Dr sold me on open surgery. I asked about the robot and he said open was better. Now that Dr is doing DeVinci. :( He was not totally honest with me. Not a happy patient. I must say my results were good which is why we wanted surgery anyway.

cajun jeff
9/08 PSA 5.4 referred to Urologist
9/08 Biopsy: GS 3+4=7 1 positive core in 12 1% cancer core
10/08 Nerve-Sparing open radicalSurgery Path Report Downgrade 3+3=6 GS Stage pT2c margins clea
r3 month: PSA <0.1
19th month: PSA <0.1
Only issue at this time is ED

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4277
   Posted 12/13/2010 6:45 AM (GMT -6)   

Dear Formy:

While I didn't opt for either type of surgery I did examine both carefully before I made a decision.  My conclusion was the same as most of the other posters, i.e. experience counts much more than which method you choose.  There are studies demonstrating that outcomes for open surgery are better when the surgeon has performed 250+ surgeries....I would think the same (or more) would hold true for robotic.  There are no guarantees but your odds improve with experience.

The other thing I would suggest is that your dad see an experienced radiation oncologist and prostate oncologist.  By seeing urologists only he is likely to get only one side of the story, i.e. surgery vs. surgery.  There are some of us on this forum who believe that radiation is an excellent choice.  In any case, this is a BIG DEAL and the side effects can be life changing.  If you don't believe me, just look at the number of posts on this forum re incontinence and ED.  Anyway, IMHO, you dad has not done his homework and is not able to make an educated decision if he does not see practitioners other than surgeons.

Good luck.

Tudpock (Jim)


Post Edited (Tudpock18) : 12/13/2010 4:48:34 AM (GMT-7)


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4849
   Posted 12/13/2010 7:06 AM (GMT -6)   
Robotics Vs open-Cut RP ???
One night in the hospital versus 2 to 4 nights helped influence me me since I have crummy insurance.

Carlos
Regular Member


Date Joined Nov 2009
Total Posts : 486
   Posted 12/13/2010 7:18 AM (GMT -6)   
I chose the most experienced surgeon I could find within a reasonalble distance from home.  My uro actually recommended combo seeds & IMRT and I may well have done that had I lived near a major treatment center.  Experience trumped everything for me.
 
Carlos

rick27
Regular Member


Date Joined Sep 2010
Total Posts : 71
   Posted 12/13/2010 8:07 AM (GMT -6)   
I had two brothers who had open, one successful one not. I decided I wanted the robot. When I found the best Dr, who my insurance covered, he suggested LRP without the robot. He had done the robot many hundreds of times but preferred plain LPR. I went along with his preference.
History: 2 brothers with prostate cancer
PSA at age 45: 4.7
PSA at age 52: 8.0 . 1st biopsy 12 cores, negative
PSA at age 55: 9.5. 2nd biopsy positive 2 of 14, gleason 3+3. both cores <5%, Start WW
PSA at age 56: 9.2. DRE normal. 3rd biopsy positive 4 of 14, 3 cores cancer<7% Gleason 3+4 in 1 core, prostate 81cc
LRP, no robot, Sloan Kettering 11/4/10,age 56
No positive margins, continent 11/12/10

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7087
   Posted 12/13/2010 9:43 AM (GMT -6)   
Formypops,
 
Speaking only about surgery -
 
My uro/surgeon now does DaVinci only (he had done open for many years). He did require, and I arranged, appointments with an open surgeon as well as a radiation oncologist before a decision was made. In all, I probably talked to 6 or 7 doctors, and two major cancer centers.
 
I did go with DaVinci, and my original surgeon (there were some limitations on out of area facilities due to my insurance). However, I would add that the time in hospital and recovery time doctors quote are averages - statistics. I was in the hospital 4 days after DaVinci, and was out of my physical workplace for almost two months (I was able to work via computer the day after I got out of the hospital). At my age (57) and health level, the statistics tell you I would have been up and around the next day.
 
As said already, the choice of a good surgeon / oncologist is most important. There are many comparisons and arguments about side effects and reasoning for a choice, but you need a good doctor to start with. An excellent doctor is better.
 
My best wishes to you and your dad.
 
 

Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2461
   Posted 12/13/2010 10:51 AM (GMT -6)   
I chose Robotic because of the reputation of my surgeon. He has done almost 2000 robotic surgeries and was highly recommended by several friends who were operated on by him. The fast recovery time was also a plus.
Age: 67 at Dx on 12/30/08 PSA 3.8
2 cores out of 12 were positive Gleason (4+4)
Davinci surgery 2/9/09 Gleason 4+4 EPE,
Margins clear, nerve bundles removed
Prostate weighed 57 grams 10-20% involved
all PSA tests since (2, 5, 8, 11, 15, 18 months) undetectable
Latest PSA test (21 months) .005

formypops
New Member


Date Joined Nov 2010
Total Posts : 12
   Posted 12/13/2010 11:12 AM (GMT -6)   
Thanks all for sharing! Maybe we will look into 1 more opinion. It really is hard that it is seems more based on the machine they are paying off or their beliefs and not really as much about the individual. You wonder if some of these hospitals force the doctors into the "new technology" so they can stay competitive so to speak?!
At least the 2 doctors he is seeing both have high #'s of experience so that is good.
Thanks again and best of luck to everyone!

April6th
Regular Member


Date Joined May 2010
Total Posts : 264
   Posted 12/13/2010 11:14 AM (GMT -6)   
I chose robotic surgery and have been very happy with my choice-my recovery was quick and overall it went really well.

The biggest deciding factor for me was that I had two friends who previously used my robotic surgeon and were very happy with how it went. Plus checking around, my eventual choice was the most experienced guy in the area and the personal consultation went well.

The open surgeon I consulted with was very professional and very experienced but I didn't have anyone I know use him. So he might have had 20 years of experience, but it might have been 20 years of so-so results (I doubt this was the case, but still, having personal recommendations carried a lot of weight).

There were some minor factors which also leaned me in the direction of robotic such as shorter hospital stay and shorter recovery.

As far as risks during surgery and outcomes---that had more to do with the quality of the surgeon than the method.

So it boiled down to the surgeon I had the most confidence in.

Dan

TTaylor
Regular Member


Date Joined Nov 2010
Total Posts : 102
   Posted 12/13/2010 3:02 PM (GMT -6)   
From what I could determine there is a much better sight picture for the surgeon doing the robotic surgery. Not to mention much less blood loss and a better chance for nerve sparring. I was pad free after 9 days. This is not to say there can't be complications but an experienced robotic surgeon wins out for me.
Stay well and blessed
TTaylor
Age 67. Robotic prostatectomy 10/26/2010, due for HT and RT in Janury 0f 2011. Eight of 12 lobes positive. Gleason Score 4+4=8, Margin envolvement was present with adipose tissue invasion and perineural invasion, glandular and stromal hyperplasia present,pT3 pNO and no evidence of metastatic adenocarcinoma.

BuiDoi
Regular Member


Date Joined Aug 2010
Total Posts : 234
   Posted 12/13/2010 3:09 PM (GMT -6)   
Tudpock18 said...
By seeing urologists only, he is likely to get only one side of the story, i.e. surgery vs. surgery. There are some of us on this forum who believe that radiation is an excellent choice. In any case, this is a BIG DEAL and the side effects can be life changing.



IMHO - Almost every man here will believe that his 'procedure' went well. Few will think differently, because they will NEVER know what the alternative would have produced.

Each has made a decision and has faith that what has happened has been fate.
"Procedure" means anything from doing nothing, thru Radiation and Surgery to whatever.

For each man , it is THEIR journey with CANCER.

The first thing is to ask - what am I doing ? = I seek to live longer and not have this cancer affect my life any more than necessary !

So - take each choice and try to understand what the CONSEQUENCES are.
If you choose to do nothing and the cancer IS more serious that reported and IF it escapes the Prostate, then you are now in real survival mode using salvage techniques. But - there are those who believe that most men will not be adversely affected by the cancer anyway. You can only trus the pathology science to indicate just how serious YOUR cancer really is !

If you choose Radiation then you must understand just what Radiation does. It COOKS the cancer, along with ALL other surrounding tissues. Radiation is NOT selective.. . .. It Kills the Cancer and the Good tissue and continues to do so for long after the machine is turned off. Dead tissue cannot work the way it did when alive. ALL these tissues will continue to die over the next three years.

The results as reported by many, would suggest that the immediate result is GREAT with the anticipated side-effects, and then it's Down from there as ED and Incontinence reportedly increasing as the cooking and scaring proceeds. MOST importantly, because the tissue is now largely SCAR-Tissue, cooked almost like a chicken, it is near impossible to THEN select SURGERY to correct any problems, because the surgeon cannot sew cooked meat !

Additionally, you must understand that the radiologist leaves the room during the procedure because RADIATION  skull   causes cancer ! ... .. . Sometime, more serious cancers, years later, assuming that it CURES KILLS (???) the Prostate Cancer that it was first treating.
Radiation at age 40 would have to be desperation stuff, because of the possible later issues... . . Radiation at 70 could be considered 'acceptable risk' given the fact that you are not 'expected' to live much longer anyway. ( Hey - Speak for yourself ! confused   ?
 
 - You will likely NEVER know, because your true GOAL is to prevent a return of cancer METS'.
If you have Robot, you should be up and about much faster than open, but does (say) two weeks of possible bed-rest needed for open-RP affect your life that much ?
For me, the answer is NO..  I was working at two weeks.     For all those I personally know, the answer is NO.

There in NO simple answer !    .. . . May you find the right choice first time !
 
PS - I suspect that MY Surgeon, who now strongly defends open-RP, is reportedly about to go to ROBOT, and I suspect that he will defend that move on the basis that it's business and SOME men will insist on ROBOT, and with his experience, he should be able to provide adequate quality, given what he truely believes !
So - IF a surgeon has the CHOICE of either open or ROBOT, then surely he can make the choice as to which could be better for YOU.
He will make the money anyway, whichever he uses, and will pay for the unused machine in the courner, if he uses open-Cut  smilewinkgrin   ..
 
Please - do have a read of:
Pages 70 to 75
..
.

Post Edited (BuiDoi) : 12/13/2010 2:40:14 PM (GMT-7)


Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 12/13/2010 3:44 PM (GMT -6)   
I had open surgery simply because robotic was not an option in my area. I felt my recovery was comparable with with the robotic guys. Two nights in hospital, and no bed rest.

Undoubtedly, robotic loses less blood loss as they pump you full of gas. I lost 750ml of blood (they said), and felt woozy with low blood pressure for a day after my open surgery. No transfusion.

But open gives improved continence levels -- this is often glossed over, especially by doctors with expensive robots that need to earn their keep. There have been studies showing open is better for continence, and an informal survey we did here about a year ago among the forum members at the time showed showed open to be markedly better in this regard.
No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4/12 cores
Non-nerve-sparing RRP 7 March 2008 age 63
Organ confined, neg margins. Gleason downgrade 4+4=8
Fully continent
Bimix worked well; now using just VED
PSA undetectable at first but now 0.3, doubling time 7 months
No radiation but ADT coming unless I can slow down the rise...

Post Edited (Piano) : 12/13/2010 1:48:32 PM (GMT-7)


JoeFL
Regular Member


Date Joined Oct 2009
Total Posts : 420
   Posted 12/13/2010 4:18 PM (GMT -6)   
Formypops,

When I was considering surgery, my uro had done both open and robot. He told me that if I chose the robot he wanted me to talk to another surgeon. He had come to the conclusion that he got better results when he had the tactile feel for what he was doing and did not have to worry about seeing through the camera eyes only...especially when they were sometimes obscured with blood or tissue. I, of course, really appreciated his frankness in telling me that he preferred open surgery.

As it turned out, he was also very experienced in the BT procedure as well and, in the end, I opted for a seeds/IGRT combo.

You will find that each case of PC is like a snowflake....thery are all unique to the individual. Go for experience, press all docs for full disclosure on possible side effects , compare the cure rates and then go with what your Dad feels the most comfortable with.

Best wishes with whatever you choose.

Joe
Age 67 PSA 4.5 Biopsy 9/4/09 Bostwick Labs 5 of 8 sections (5 of 11 cores) positive-Gleason 3+3=6 Stage T1
BT on 12/11/09 (84 seeds of Palladium 103) Home same day/no catheter. Some burning, frequency, urgency for 6 weeks. No incontinence, mild ED. Normal activity within 3 days. 25 IGRT sessions ending 3/22/10 - some fatigue until 30 days after last treatment. PSA on 5/26 - 0.1 PSA on 9/1 - 0.1

DJBearGuy
Veteran Member


Date Joined Dec 2008
Total Posts : 821
   Posted 12/13/2010 7:46 PM (GMT -6)   
formypops,

You may find that when your dad weighs one procedure against the other, for him they may come out pretty much the same. At any rate, don' forget other considerations, such as the overall quality of the hospital in general. They are certainly not all the same!

DJ

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3743
   Posted 12/13/2010 8:11 PM (GMT -6)   
I did not have the luxury of shopping around. My PSA was rising faster than the national debt: 17, 22, 23 in 3 tests taken about 3 weeks apart. I needed to do something.

In my area there were two very experienced surgeons. One did open surgery, the other DaVinci. I had heard that open surgery had slightly better QOL results but the data was old.

I spoke with some people who regularly watched both surgeons in the OR and asked opinions. The DaVinci surgeon was said to be a nice, even tempered guy and very neat. The open guy was not friendly to staff and was called the "Sanguinator" for the way he left the OR. Since their results were identical, at least anecdotally, (I did not have detailed data or reviews to study), I elected to go with the nice guy, and DaVinci.
I will never know if I made the right decision.

Jeff (PSA <0.01 and alive to tell about it)

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 12/13/2010 8:37 PM (GMT -6)   
1. Less blood loss is always a good thing. Transfusion can be risky.

2. Less cutting is always good. The more that is opened up and disturbed, the greater the risk for infection, the greater the risk for future complications.

3. The better view from a 10 x camera alwasy made sense to me when you are cutting nerves and stuff.

4. The instruments are smaller on the robot. When working in a restricted area, it seemed better to me to not have hands in the way, and to have that camera looking at everything.

5. Shorter recovery time.

6. Experience. That is what my surgeon was most experienced in.

7. Hype. The buzz out there is that DaVinci is better. I bought into it.

8. Even tho age was not a big consideration for me, I think that robotic is better for older men. The less disturbance , the better.

Good luck.
Goodlife
 
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01
1 year psa (364 days) .01
15 month PSA <.01
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